Shortcomings Of Current Igrt Strategies
Current IGRT techniques include the use of cone-beam CT and implanted fiducial markers , which may be used in conjunction however, both have their limitations. CBCT alone has poor soft tissue resolution, limiting the accuracy of prostate-prostate matching . The use of radiopaque fiducials allows for rigid-registration but provides little to no information about organ deformation, seminal vesicle location, or bladder or rectal distension . The placement of fiducial markers is also an invasive procedure. Uncertainties in current IGRT strategies require larger planning margins to account for internal margin and set-up error, which can increase toxicity. Inter-fraction volumetric changes of the prostate gland have also been observed in moderate and profound hypofractionation schedules and, with the move toward ultra-hypofractionation, direct visualization of the prostate serves to ensure dose coverage.
Radiation Therapy For Prostate Cancer
Radiation therapy is an effective treatment that kills prostate cancer cells by using high energy rays or particles. The radiation can be delivered in several ways, including brachytherapy and external beam radiation that projects the energy through the skin. Radiation therapy for prostate cancer is best delivered by experienced radiation oncologists who work in high volume centers of excellence.
Radiation therapy can:
- Treat both early stage cancers of the prostate gland and more advanced cancers that may have spread beyond the prostate
- Be used alone or with other treatments such as hormone deprivation
- Treat recurrent prostate cancer following surgery
- Treat men with limited spreading prostate cancer to reduce the tumors size and improve survival and quality of life
- Slow cancer growth, reduce fracture risk
- Be used as a palliative treatment to address pain from advanced cancer
Why Does A Tumor Need To Be Tracked In Real Time
As the patient naturally breathes in and out during radiation therapy, a tumor can potentially shift in position sometimes by as much as an inch or more. This movement can make it difficult to keep the radiation beams precisely focused on the tumor throughout the treatment session. Prior to the development of MRI-linac, it was necessary for a radiation oncologist to treat the entire area in which the tumor might travel during the patients normal breathing cycle.
The MRI-linac monitors the movement of a tumor in real time and continually adjusts the radiation delivery to compensate for any shift in its position. The MRI-linac also monitors the positioning of a tumor and the surrounding soft tissues from one treatment session to the next and then modifies the radiation delivery as necessary to account for any changes.
Don’t Miss: What To Expect After Prostate Cancer Surgery
Different Procedures Call For Different Mri Second Opinion Specialists
Having an MRI diagnosis by a radiology sub-specialist is particularly important. Radiologists may be generalists reading a wide range of exams or specially trained experts who focus on a particular area. XMRI.com has handpicked a team of highly-trained sub-specialists to give you peace of mind about your MRI second opinion. These physicians have the extra training and experience to assess small nuances on your exam and their MRI second opinion may make the important difference in your diagnosis. When you book your MRI second opinion, review the XMRI.com website carefully and select the correct sub-specialist. If you are unsure, contact XMRI.com for assistance.
How Is This Different From Getting An Mri In The Radiology Department
The MRI imaging performed for radiation therapy planning is high quality since the scanner is the same state-of-the-art scanner used for diagnostic scans in radiology. The big difference is that we will be able to perform the MRI scan with the patient in the treatment position and with their custom radiation therapy immobilization equipment in place, which will allow us to plan the radiation treatments more accurately.
Recommended Reading: How To Tell Prostate Cancer
Enquire Now About The Mridian
The MRIdian is available at our centres in Oxford and Cromwell Hospital in London. Your cancer specialist can refer you for a consultation. Were recognised by all major insurers and well help you with transport depending on treatment and locations, when required. Self-pay options are also available.
Current Experience Of Mrgrt In Prostate Cancer
Knowledge and experience of prostate MRgRT, on both Elekta Unity and Viewray MRIdian systems, has developed rapidly in the past few years. With MRgRT presenting a revolution in RT delivery, development of workflow and assessment of patient outcomes were initial priorities. Illustrative workflows are shown for the 1.5T MR-linac and the 0.35T MR-linac systems . Such parameters were detailed by the Amsterdam VU team who described their experiences after 700 fractions were delivered .
MRgRT involves a multi-disciplinary team of radiographers, physicists, and clinicians. Most global experience is with daily re-contouring and re-planning. For example, the Amsterdam team reported that 97% of their delivered fractions were online ART plans .
The average duration of a delivered fraction is around 45 min, during, which time the patient is required to be on the treatment couch. The Amsterdam team also reported on a number of patient-reported outcomes and found that noise was the most common complaint . Noise may be partially mitigated by the use of noise reduction headphones, which also enables communication between patients and radiation therapists during treatment . Our experience to date is that patients have not had any significant problems with the treatment, and patient experience is positive . This is echoed by other practitioners including the group at VU University Medical Center .
You May Like: Early Warnings Of Prostate Cancer
Connecting You With The Most Advanced Appropriate Care
The ViewRay MRIdian Linac® MRI-guided radiation therapy system is available at the Henry Ford Cancer Institute at Henry Ford Medical Center-Cottage in Grosse Pointe Farms.
Our experienced radiation oncology team can help connect you with the most appropriate technology for your type of cancer. For more information, call .
Mr Imaging During Treatment
The MR-Linac offers the ability to collect multiple MRI images daily, before and during treatment. The quality of these images are not as high as those obtained from a 3T diagnostic MRI machine, yet it provides a wealth of data which otherwise would have been difficult to obtain, as daily diagnostic MR imaging is expensive and time consuming. This information will enable radiation oncologists to study changes in tumours during the course of radiation treatment and carry out doseresponse studies.
One of the more exciting possibilities of MR-guided radiotherapy is the ability to perform functional imaging such as diffusion-weighted imaging during treatment.63 DWI is sensitive to the Brownian motion of water within tissues and can be used to discriminate malignant from benign tissue. Malignant tumours have a low ADC value.64 DWI images are also used to monitor response to treatment, post-chemotherapy or radiotherapy, to differentiate post-therapy changes from active tumour and to detect recurrent tumour.65
Don’t Miss: Bone Scan Preparation For Prostate Cancer
Literature Search And Information Collection
Using the Medline/PubMed and Web of Science databases, we performed a search with the keywords: magnetic resonance imaging or MRI and prostate cancer, and their combination with the following terms: diagnosis, radiotherapy, MR-LINAC, MR-guided radiotherapy, simulation, treatment planning, image guidance, and motion. Only full journal articles published in English were included. The literature search yielded a huge number of publication records. The literature selection for this review did not claim to be exhaustive but illustrative of the MRI acquisition techniques used in prostate cancer MRgRT. The authors had to subjectively select the most representative and most relevant studies in consensus, preferably published in the last 5 years, for review. The full articles were read and the relevant information on MRI acquisition were extracted.
Besides literature search, the user manual of âMarlin 1.5 T for Elekta Unity â Instructions for Use Release 5 Marlinâ and unpublished documents such as the clinical protocols and research reports in our hospital were also used as information sources.
We present the following article in accordance with the Narrative Review Checklist .
Radiotherapy For Prostate Cancer Treatment
Radiotherapy is often preferred over surgery for prostate cancer as a less invasive treatment option and provides similar rates of cure. Having radiotherapy on the MRIdian may be suitable for you if your prostate is not too large and your urinary symptoms are not particularly troublesome. As each treatment can take over an hour, you must be comfortable lying within the MRIdian while holding your urine in for that length of time.
You may also be able to have radiotherapy on the MRIdian if youve already had radiotherapy to your prostate. You can find out more prostate re-irradiation here.
Your consultant will discuss your prostate cancer diagnosis, treatments to date and overall health with a multidisciplinary team of oncologists and urologists to decide if this treatment is right for you. By working together, theyll create a personalised treatment plan that may include radiotherapy, surgery and/or drug treatments. If they recommend that MRIdian is the best option for you, your oncologist will explain the treatment in detail to you and provide you with written information about what to expect, as well as give you plenty of opportunity to ask questions.
This is our commitment to offer world-class care to every patient with cancer.
You May Like: When To Start Prostate Exams
External Beam Radiation Therapy
This is the most common type of radiation therapy, and it is painless. Before treatment, your radiation team will use computerized tomography scans and magnetic resonance imaging scans to map out the location of the prostate and tumor cells.
During each treatment session, X-ray beams are focused on the targeted cancer areas. Oncologists can change the intensity of doses and radiation beams to better deliver high doses of radiation to tumor cells while delivering lower doses to surrounding healthy tissues.
What Type Of Technology Does Mri
We use the ViewRay MRIdian technology. It combines diagnostic-quality MRI with a linear accelerator to produce therapeutic radiation beams. Worldwide, fewer than 50 hospitals have this cutting-edge technology. Our MRIdian in Lebanon is one of only two in New England.
Being treated with MRIdian is similar to having a diagnostic MRI but a bit quieter. We have noise-canceling headphones and heated blankets to help make you more comfortable. There is also a microphone that allows you to speak to us throughout your treatment. You may also receive medication before your treatment, if needed, to make the enclosed space of the MRI more tolerable. Each MRI-guided radiation therapy session typically takes longer than other treatment options.
Don’t Miss: How Long Does Da Vinci Prostate Surgery Take
Magnetic Resonanceguided Prostate Stereotactic Body Radiation Therapy With Daily Online Plan Adaptation: Results Of A Prospective Phase 1 Trial And Supplemental Cohort
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Harvard Medical School, Boston, MassachusettsDepartment of Radiation Oncology, University of California, San Francisco, California
- Search for articles by this author
Expansion Of Clinical Roles
The role of the radiographer is likely to expand to take the lead in the online workflow. This may reduce the need for a clinician to be present during treatment and could improve patient throughput. A clinician-lite approach has been adopted at the Christie for simple prostate treatments58 and at our institution, we are in the process of training the radiographers to perform online contouring. Pathmanathan et al demonstrated good agreement between radiographer contours and the gold-standard on MRI.21
Recommended Reading: Do Male Dogs Have A Prostate
What Should I Wear
You will need to change into a hospital gown. Our changing areas are private and there is a secure locker for your clothes and belongings. It is best if you leave valuable items at home. You will need to lock up all of your belongings, including your cell phone and credit cards. If you are wearing anything metallic, such as jewelry, dentures, eyeglasses, or hearing aids that might interfere with the MRI, we will ask you to remove them. Patients who are having a brain / head MRI should not wear make-up as some brands contain metal.
Overview Of Your Treatment On The Mri
For the first time, cancer patients in New England will have a cutting-edge option for radiation treatment, known as MRI-Guided Radiation Therapy . This video highlights the two components of the new MRI-RT, a 3 Tesla MRI scanner modified for radiation therapy planning called the MR Advanced Procedure and Simulation unit and an integrated MRI-guided linear accelerator . The MAPS unit includes a high-field strength magnet for diagnostic quality imaging for initial radiation therapy planning. The MRI-LINAC, meanwhile, is a state-of-the-art hybrid device that integrates a modified, lower-field MRI scanner with a linear accelerator to reduce the magnetic interference on the radiation beam.
Also Check: Prostate Cancer Recovery Time After Surgery
Ethics Informed Consent And Safety
The final protocol was approved by the ethics committee of the University of Heidelberg, Heidelberg, Germany . The SMILE study complies with the Helsinki Declaration in its recent German version, the principles of Good Clinical Practice and the General Data Protection Regulation as well as the Federal Data Protection Act . The trial will also be carried out in accordance with local legal and regulatory requirements. The ClinicalTrials.gov identifier is NCT04845503.
What Should I Expect During Mri
- At the beginning of every treatment session, we will perform an MRI safety screening to ensure nothing has changed since your last visit.
- Our team will then position you on the treatment table, take a fresh MRI scan, and compare this new scan with the original scan used to create your radiation treatment plan.
- If anything on the scan has changed, your team may need to adapt the radiation treatment plan to account for movement of your tumor and organs.
- Once the highly specialized team is satisfied with the radiation treatment plan and targeting, you will receive your treatment.
- The radiation delivery on the MRI-LINAC is fully integrated with the MRI. This unique technology means the system can deliver treatment radiation beams and monitor the target area at the same time. The radiation beams are precisely shaped to maximize the dose to the target while minimizing the dose to the surrounding healthy tissue.
- While the radiation beam is on, the MRI-LINAC is capturing a constant video of the tumor and/or nearby organs with its MRI and acting on them at sub-second speed. If the tumor or a critical organ moves beyond a boundary defined by your physician, the radiation beam automatically pauses when the target moves back into the predefined boundary, treatment automatically resumes. What this means is that you get the correct amount of radiation to the correct location.
Recommended Reading: Bone Cancer From Prostate Cancer
Request An Appointment At Moffitt Cancer Center
Please call for support from a Moffitt representative. New Patients and Healthcare Professionals can submit an online form by selecting the appropriate button below. Existing patients can call . for a current list of insurances accepted at Moffitt.
NEW PATIENTS To request a new patient appointment, please fill out the online form or call 1-888-663-3488.
REFERRING PHYSICIANS Providers and medical staff can refer patients by submitting our online referral form.
Moffit now offers Virtual Visits for patients. If you are eligible for a virtual appointment, our scheduling team will discuss this option further with you.
Moffitt Cancer Center is committed to the health and safety of our patients and their families. For more information on how were protecting our new and existing patients, visit our COVID-19 Info Hub
Limitations Of Mrgrt For Prostate Cancer
There are limitations to MRgRT for prostate cancer. The process of MRgRT provides a significant paradigm shift in the operation of radiotherapy departments, which necessitates updated safety training for staff, including all aspects of MR safety. Online ART requires the attention of several staff members for each treatment, often including a radiation oncologist, multiple radiographers and a physicist. Obviously, the person-hours required to deliver MRgRT are currently high when compared to traditional linac treatment, however efficiencies are likely to be forthcoming over time.
From a logistical point of view, there is limited availability of MR-linac machines and, as a result, clinician familiarity with such systems and online adaptive planning is still progressing. The predominance of radiation oncology experience until now has been centered on CT imaging and therefore the nuances and technicalities of MRI imaging are still being learned.
Another limitation of MRgRT is the risk of over-intervention with MRI imaging. The session MR image acquired at the beginning of each days treatment is a snapshot in time and one may devise a new plan based on that particular image with compromise of PTV coverage due to proximity of an OAR . OARs may move intra-fractionally and therefore may have unnecessarily compromised target coverage for that day.
Also Check: Brca Testing For Prostate Cancer
What Are The Side Effects Of Prostate Radiotherapy With The Mridian
Both surgery and radiotherapy carry risks of damage to the surrounding organs including incontinence, impotence and diarrhoea. The precision of MRIdian radiotherapy means you can expect these side effects to be reduced. A study from VU University Medical Centre in Amsterdam showed a low occurrence of bowel and urinary side effects in patient-reported and clinician-reported outcomes .
With MRIdian, side effects are fewer and less severe than with conventional radiotherapy. However, you may still experience some of the following side effects. For patients receiving treatment on the MRIdian over five consecutive days, a prostate spacer is inserted prior to treatment to further reduce the risk of side effects from prostate radiotherapy.
References
You may experience these during your treatment course, but theyll usually disappear within three to four weeks:
- Discomfort on passing urine
- Needing to pass urine urgently
- Loose and frequent bowel movements